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"连接":将以人为中心的叙事干预融入电子健康记录的整合:一项实施研究。

"Connection": The Integration of a Person-Centered Narrative Intervention into the Electronic Health Record: An Implementation Study.

机构信息

College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.

Division of General Internal Medicine, Department Medicine, School of Medicine, Aurora, Colorado, USA.

出版信息

J Palliat Med. 2020 Jun;23(6):785-791. doi: 10.1089/jpm.2019.0376. Epub 2020 Jan 6.

Abstract

Incorporating patient narratives into the electronic health record (EHR) is an opportunity to integrate patients' values and beliefs into their care and improve patient-clinician communication. The study's aims were to (1) identify barriers and facilitators influencing the implementation of a cocreated patient narrative intervention and (2) assess the acceptability/usability of the patient's narrative from the perspective of key stakeholders-the patient and acute care bedside nurse. We used an implementation design using mixed methods. Twenty patients and 18 nurses were enrolled from five units in an acute care hospital. For patients, the narrative intervention provided an avenue to discuss and share how illness has impacted their life in psychological, social, and spiritual belief domains. For nurses, the ability to read the patient's narrative provided benefits that fostered improved communication and more connection with their patients. Despite successfully meeting recruitment targets, time was the largest barrier for patient and nurse participants. Overall, the nurse participants gave high ratings on most of the items on the System Usability Scale with one exception-EHR integration. The lack of EHR integration on the System Usability Survey corresponds with the nurses' stated desire for a prominent location of patient narratives in the EHR. The patient narrative intervention was acceptable and usable for hospitalized patients and nurse participants. Our study demonstrates that a cocreated patient narrative intervention provides avenues for patients and nurses to connect despite being in hectic acute care settings. ClinicalTrials.gov NCT03391115.

摘要

将患者叙事纳入电子健康记录 (EHR) 是将患者价值观和信仰融入其护理并改善医患沟通的机会。本研究旨在:(1) 确定影响共创患者叙事干预实施的障碍和促进因素;(2) 从患者和急性护理床边护士等主要利益相关者的角度评估患者叙事的可接受性/可用性。我们采用了混合方法的实施设计。从一家急性护理医院的五个病房招募了 20 名患者和 18 名护士。对于患者来说,叙事干预为他们提供了一个讨论和分享疾病如何影响他们心理、社会和精神信仰领域生活的途径。对于护士来说,阅读患者叙事的能力带来了好处,促进了更好的沟通,并与患者建立了更多的联系。尽管成功达到了招募目标,但时间是患者和护士参与者面临的最大障碍。总体而言,护士参与者在系统可用性量表的大多数项目上给予了高度评价,只有一个例外-EHR 集成。系统可用性调查中缺乏 EHR 集成与护士表示希望患者叙事在 EHR 中占据突出位置的愿望相符。住院患者和护士参与者对患者叙事干预可接受且可用。我们的研究表明,尽管处于繁忙的急性护理环境中,共创患者叙事干预为患者和护士提供了联系的途径。ClinicalTrials.gov NCT03391115。

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